Walking for Better Outcomes and Recovery: The Effect of WALK-FOR in Preventing Hospital-Associated Functional Decline Among Older Adults

Background: In-hospital immobility of older adults is associated with hospital-associated functional decline (HAFD). This study examined the WALK-FOR program's effects on HAFD prevention. Methods: A quasi-experimental pre-post two-group (intervention group [IG] n = 188, control group [CG] n = 189) design was applied in two hospital internal medical units. On admission, patients reported pre-hospitalization functional status, which was assessed again at discharge and 1-month follow-up. Primary outcome was decline in basic activities of daily living (BADL), using the Modified Barthel Index. Secondary outcomes were decline in instrumental ADL (Lawton's IADL scale) and community mobility (Yale Physical Activity Survey). All participants (75.1 +/- 7 years old) were cognitively intact and ambulatory at admission. The WALK-FOR included a unit-tailored mobility program utilizing patient-and-staff education with a specific mobility goal (900 steps per day), measured by accelerometer. Results: Decline in BADL occurred among 33% of the CG versus 23% of the IG (p =.02) at discharge, and among 43% of the CG versus 30% in the IG (p =.01) at 1-month follow-up. Similarly, 26% of the CG versus 15% of the IG declined in community mobility at 1-month follow-up (p =.01). Adjusted for major covariates, the intervention reduced the odds of decline in BADL by 41% (p =.05) at discharge and by 49% at 1-month follow-up (p =.01), and in community mobility by 63% (p =.02). There was no significant effect of the intervention on IADL decline (p =.19). Conclusions: The WALK-FOR intervention is effective in reducing HAFD.